a colloquial keratin pearl in the anterosuperior quadrant of the mesotympanum juxtaposed to the malleolar manubrium or in the second-most common location of posterosuperior quadrant behind an otherwise healthy appearing eardrum [32, 33].

Since the use of fully-threaded cortical screws is recommended by the Association for the Study of Internal Fixation Manual of Internal Fixation, fully-threaded cortical screws were used instead of malleolar screws in one study [28].

8) Malleolar fractures are typically because of rotational mechanism and lower energy fractures whereas the primary result of axial loading forces in which talus is forced proximally into distal tibia producing the "explosion" fracture of articular surface.

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